OPOP conference, September 03 09, Ottawa. Telepsychiatry in a private practice setting. I, Hugues Richard, perceive no conflict of interest with this presentation but present companies with which I have worked and consulted for: Lundbeck Canada Ontario Telemedicine Network (OTN). Disclosure….
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OPOP conference, September 03 09, Ottawa
Telepsychiatry in a private practice setting
I, Hugues Richard, perceive no conflict of interest with this presentation but present companies with which I have worked and consulted for:
1. Discover the benefits and limitations of working with OTN.
2. Find out which patients do best, and if there are any contraindications.
3. Discuss the future of telepsychiatry and ways it can be improved.
My practice: general psychiatry, adult, psychotherapy, trauma work, consultation liaison, community psychiatry
Private office: Stittsville.
Meet my two assistants…
to lose control on appointments,
To lack efficacy or accountability,
To become impersonal,
To be left to my own self.
How is it going to work for new patients?
Will I survive working 5 days in a row?
How are the patients and staff going to react to this?
Smooth process: booking, liaison;
Professionalism and reliability;
Excellent technical support on line (bridge), and in vivo;
1 patient declined, preferring to wait to see me in vivo
Negative perception from one agency clinical director who thought I was less available
Safety ( pandemic, road accidents…)
Environment (↡carbon footprint)
No disruption in family life
Available to my in vivo practice
SOME PATIENTS WILL SPECIFICALLY PREFER TELEPSYCHIATRY
1.Distance is perceived as protective
2. Control is maintained, can walk out easily
3. Neutral place
4. Those who enjoy technology or like novelty
65 to 75% of patients who could have benefited from telemedicine chose one-to-one visits.
Different with patients from the North: all but one have used OTN.
Patients’ satisfaction close to one on one visits.
More qualitative studies needed to support this.
Very accurate compare to in vivo
The non verbal communication lacks compare to the verbal
Most studies show that the “main obstacles to telepsychiatry have to do with physicians and patients adjusting…”
Delay to get a studio available; turn around between one and two weeks, at least 48 hrs
Registration at an agency makes it more public
Having other people involved makes it very hard for some patients to trust (bridge, hackers, OTN = government)
I had not anticipated this one!
Progress notes written on same lap top I use on site;
Consultations dictated to and transcribed by my assistant →notes sent rapidly to everyone involved
Lives >160 k from my office, but a studio is available 4 k from her
Would you have offered her videoconference?
Patients who refuse this modality (informed consent needed)
Violent / unstable / impulsive patients
Patients requiring special monitoring when not available
Patients with specific symptomatology that could be exacerbated by the use of communication technology (Z with hallucinations for instance)
Patients with whom news must be shared in person, because it could cause significant emotional reactions (HIV test results)
Patients who have hearing, visual, cognitive deficits that limit their ability to communicate via this technology
Referred to me by FP and SW for symptoms of depression and anger
SW attends the session
I have completed the assessment, at least that’s what I thought… But apparently not her!
Starts throwing chairs around,
Screams that she’s had it; nobody listens to her, and she is to kill herself
SW is hysterical
Me too !!!
Have phone and fax very close by if not in the studio
Have certification forms at hand
Have a coordinator of care on site
Have triage done beforehand
Patient = realistic expectations
Good rapport with ER staff
Telemedicine equipment recently installed in my office allows for weekly intensive sessions.
Also use of Skype (once) and numerous emails.
I talk with his SunLife case manager on phone
Presently back to work full time
No need for hospitalization
His wife is still with him
Telepsychiatry is very valuable in many different ways
It has shown that it is an accurate way to assess and treat patients;
It offers psychiatric services to people who have no direct access to such services
For some patients, it’s their preferred way of treatment
It is not for psychiatric emergencies
It is not to replace one on one sessions
It might be a cost saving treatment
Obstacles are mostly from professionals
To me, it is an exciting way to practice;
Without telemedicine, I would not have been able to serve the northern communities last winter.
Need to know more about who are the best candidates
Contraindications to be more precisely defined
“Telehealth-clinical guideline and technical standards for telepsychiatry”,
Gilles Pineau, Khalil Mogadem, Carole St-Hilaire, Eric Levac, Bruno Hamel et al. (AETMIS 06-01) Montreal AETMIS 2006 xxii-72p.